Minimally Invasive Single-Site Cholecystectomy in Obese Patients: Laparoscopic vs. Robotic

The Influence of Obesity on Cholecystectomy Outcomes: A Systematic Review of Laparoscopic and Open Approaches

This systematic review evaluates the impact of obesity on the outcomes of laparoscopic versus open cholecystectomy, analyzing data from five key studies. The review explores differences in operative times, complication rates, conversion rates, and recovery times among obese patients undergoing these surgical procedures. The findings indicate that while laparoscopic cholecystectomy in obese patients tends to require longer operative times, it does not significantly increase complication rates compared to open cholecystectomy. However, the risk of conversion to open surgery is modestly elevated. The review highlights the necessity for surgical guidelines to adapt to the challenges posed by obesity, recommending advanced training and innovative technologies to improve surgical outcomes. Limitations such as study design heterogeneity and variability in defining obesity underscore the need for further research. This review contributes to optimizing surgical care strategies and improving patient outcomes in the growing demographic of obese surgical patients.

Robotic cholecystectomy with a new port placement-is it really beneficial?

OBJECTIVE

This study compared the effect of robotic cholecystectomy (RC) with a new port placement versus that of laparoscopic cholecystectomy (LC) on surgical pain and postoperative complications.

METHODS

We prospectively collected medical data from 100 patients who underwent cholecystectomy (RC = 50, LC = 50) from March 2017 to January 2019. In the RC group, ports were positioned in the left-lower, mid-lower, and umbilical areas. In the LC group, ports were placed in the xiphoid, right-upper, and umbilical areas.

RESULTS

Patient characteristics were similar between the two groups. Pain levels at 2, 4, and 8 h were significantly lower in the RC group than in the LC group (p = 0.04, 0.02, and 0.02, respectively). The LC group received more analgesics after surgery (RC = 0.3 ± 0.5 vs. LC = 0.7 ± 0.9, p = 0.03). However, the total medical cost was significantly higher in the RC group (RC = 7355.2 ± 1270.9 USD vs. LC = 4814.8 ± 1572.5 USD, p < 0.01). Mean operative time, length of hospital stay, and postoperative complications were not significantly different between the two groups.

CONCLUSION

Regardless of the surgical procedure, postoperative complications were similar. RC with the new port placement can be recommended for patients who are more concerned about postoperative pain, incision, and hospital stay than surgical cost.